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APPLICATI�'''+1 FOR CONSTRUCT"ON PERMIY ���� <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT � <br /> �� <br /> BUILDING DEPARTMENT HEATING SYSTEM: GAS ❑ ELECTRIC ❑ _ I <br /> 259-8810 <br /> ❑ DEMOLITION O CONiBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ �IGN <br /> �OWNER � ldAILADDRE55 I CITY ZIP PNO,N/E <br /> /�TW �Y�F� i/I�4 1l A I �1 55 � � NW I CITY ZI�,� PH/ �I��/�� <br /> AFCHRECTORDESIGNER AIAILAD�RESS ' CITV AP PHONE <br /> s Ku�r�Y AS�o� I������i� .SV�� ��rrz� ��lSg 8��-- y/�O <br /> GENEfiALCONTPACTOR IAAILAD�RE55 CITV "P PHONE TqTELICENSEI <br /> �9 eTcu �IrJdIFs T�D:�� ' <br /> h1ECMANICALCONTRACTO lAAILADOflE$5 QTV ZIP PHONE STATELICENSEN <br /> PIUMBINGCONTRACTOR MAILAOOFlESS CIN 21P PHONE STATELICENSEu <br /> CONTRACT PRICE GF WORH <br /> �UP�;�1i� <br /> OESCRIBE\}'ORK AND$OUAF F TAGE RIVOL 5 , � � CONTFCT PEflSON�ND PMONE NO. <br /> II w 5 - , -� -�anu� i 2 /T ' � ��5 <br /> I � `bZ$ Li vl �it � / .ld� <br /> i . � . . �� Y v �- �e�M�l `�� i HEREBY CERTIFY ThIAT I HAVE READ AND EXAb11NED THIS <br /> rnaPos Fe oiruc----- APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br />� . '�'`�7� PROVISIONS OF I.AWS AND ORDINANCES GOVERNING THIS TYPE JF <br /> � - ' �ecn OESCRIPTION PROPERTV�SNO'.NBELGWORATTACHTWOCOPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HFREIN Ofi <br /> � NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or BLOCK — OF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAVJ REGULATING CONSTRUCTION OR THE <br /> PERfORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM TfiE WORK FOR WHICH <br /> FlPPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL TAX I.O.NUMBER CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> CONSTPUCTION LOAN LEIJDEF,A�DRESS,1 ELE�HOrIE NIIM�ER —� <br /> ��`'� ���y_� <br /> � PROJECTADDRES ,/ /� � ��O �� s�,:+e*une onie <br /> 7� - /�/ ! r CIiY0U5tYE55ULEN5EN0. - <br /> . PLUM8ING MECHANICAL <br /> N0. TYPE OF FIXTURC OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C-A/HNDLG UNITS-H.P. <br /> � BATHTUB FORCED AIFl SYSTEMS-B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) � UNIT HEATERS-B.T.U. M ; <br /> SHOWER CLOTHES DRYERS � <br /> KITCHEN SINK 8�ISP � VENTILATION FAN ; <br /> ----r-- <br /> DISHWASHER � RANGEHOOD <br /> LAUNDRY TRAY ; WATER HEATER ' <br /> CLOTHES WASHER � WOOD STOVE � <br /> URINAL METAL FIREPLACE(WOOD BURNING) � <br /> DRINKING FOUNTAIN � FIREPLACE INSERT ; <br /> fLOOR DRAIIJ HEAT PUtdP � <br /> BAGKFLOW PREVENTERS ; GAS PIPING ; <br /> fl00F DRAINS-RAINLEADERS � EXHAUST Fl,N <br /> SINK(SERVICE-BAR,ETC.) ; _i_ <br /> � � _ <br /> � �_ <br /> — � <br /> � � <br /> S��TOTAL $ ; SUB TOTAL 5 <br /> PERMIT S PEAMIT S I <br /> T(iTAL FEE S ; TOTAL FEE S ; <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACK REFRSETBNCK SIOESETOACK PIANCHELKNUkBER FEE�y�`/�� RECEIPTNO <br /> �O�S2J � �_`,�3�J <br /> USEZONE LOTAR[A VACANTSITE FEES VALUATION PEE <br /> ❑ YES f_l NO gUILDIf1G ��7,�jQ _���_ <br /> iYPE OF CONSi. NO.OF STORIES O�Curu¢v ne oro::ELLiR�uNns - — <br /> -1T'/ I 2 �A �P � PLUMBING ��' � <br /> �W�/ <br /> SIZEOFBIDG. FIFESPRINHLERSREO'0 B SEMENT MECHANICAL <br /> v95c Nb ❑ ves �:No --� <br /> OCCUPANCYLOAG FIRE ALA�fR�fA jFlEQ'D HEIGHT LIMITATIUN ADDITIONAL PLAN CHECK � <br /> `K% ' <br /> OTHEF <br /> REASON � // �/ - ��-�- <br /> H1N e l��j STATE BUILDIMG SURCHAFGE � <br /> !/IWil� <br /> INTAKEOY PlrtNS4PPFOVEDBY CITYOFEVERETT PU�LICNJORK3 ' <br /> JM LOCAL SALES <br /> on.� G �� TAX CODE IS 3105 Tara� <br />